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See a sample rate comparisonHCPCS C7542 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)
| Key Fact | Detail |
|---|---|
| Service Type | Outpatient PPS Miscellaneous Surgical Procedures |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for C7542 |
National average reimbursement for HCPCS C7542 by major payers:
$430.50
$N/A
$8,124.78
$N/A
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HCPCS C7542
5 of 25 sample ratesHigher to lower in this preview
Ochsner Medical Center
$13,593.00Published rateUpson County Hospital Inc, Upson Regional Medical Center
Upson County Hospital Inc
$3,065.00Published rateImperial Calcasieu Surgical Center LLC, Christus Imperial Calcasieu Surgical Center
Imperial Calcasieu Surgical Center LLC
$622.00Published rateGi Diagnostic Center
$385.00Published rateMesquite Surgery Center LLC
$105.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS C7542 vs. Other Miscellaneous Surgical Procedures Codes
The HCPCS C7542 code is part of the Outpatient PPS services used for Miscellaneous Surgical Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS C7542 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| C7541-HCPCS | Moderate | Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
| C7542-HCPCS | Moderate | Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
| C7543-HCPCS | Moderate | Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C7542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C7542 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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